Stop Leaving Money on the Table: Avoiding Common Billing Mistakes in Your Medical or Dental Practice

A critical component of that operational success is accurate and timely billing. Unfortunately, errors in the complex medical and dental billing world can easily lead to delayed payments, frustrating denials, wasted staff hours, and significant lost revenue.

At Legacy Practice Solutions, LLC, we partner with practices across various specialties and consistently see how seemingly minor billing oversights can create major financial challenges. The positive takeaway? Many common errors are preventable with the right systems and attention to detail. Here are our top tips for safeguarding your practice's financial health by avoiding costly billing mistakes:

1. Master Patient Information Accuracy

• The Mistake: Incorrect or incomplete patient demographic information (name misspellings, wrong date of birth, incorrect address) or outdated insurance details (wrong policy/group number, inactive coverage).
• The Cost: Claims get rejected or denied right out of the gate, forcing your staff to spend valuable time investigating, correcting, and resubmitting.
• The Fix: Institute a firm policy: verify all patient demographic and insurance information at every single visit. Things change frequently. Scan insurance cards (front and back) and photo IDs. Emphasize the critical importance of accuracy with your front-desk team.

2. Ensure Coding Precision (Procedure & Diagnosis Codes)

• The Mistake: Using incorrect, nonspecific, or outdated procedure codes (like CPT® for medical or CDT® for dental) or diagnosis codes (like ICD-10-CM). This also includes the improper use or omission of required modifiers that provide essential context to payers.
• The Cost: This can lead to underpayments, denials for lack of medical necessity, increased scrutiny from payers, compliance risks, and potentially costly audits.
• The Fix: Continuous education is key. Ensure your billing staff, coders, and clinicians responsible for code selection are up-to-date. Always code to the highest level of specificity justified by the clinical documentation. Ensure patient records clearly support the necessity and specifics of the services billed and the diagnoses linked. Stay current with annual code set updates and individual payer guidelines.

3. Prioritize Pre-Authorization and Eligibility Verification

• The Mistake: Failing to rigorously verify patient eligibility and specific benefits, or neglecting to secure necessary pre-authorizations before services are rendered.
• The Cost: You may perform services that aren't covered under the patient's plan, or claims will be denied outright for lack of prior approval. This often makes it difficult, if not impossible, to collect payment later.
• The Fix: Make eligibility and benefits verification a non-negotiable step prior to the patient's appointment or procedure. Check for active coverage, specific service limitations or exclusions, co-pays, deductibles, and whether pre-authorization is mandated for the planned services. Carefully document the verification details (date, time, representative's name, reference number).

4. Conquer Timely Filing Deadlines

• The Mistake: Submitting claims after the insurance payer's specified filing deadline.
• The Cost: This usually results in an automatic, irreversible denial. It's equivalent to giving away your services for free.
• The Fix: Know the timely filing limits for every single insurance plan you accept – these can vary dramatically (e.g., 90 days, 180 days, one year from the date of service). Implement a reliable workflow to ensure claims are generated, scrubbed for errors, and submitted promptly, well before the deadline approaches.

5. Implement Robust Denial Management

• The Mistake: Receiving claim denials and letting them sit, writing them off without investigation, or having an inefficient process for follow-up and appeals.
• The Cost: Accepting preventable revenue loss. Furthermore, you miss crucial feedback that could highlight recurring errors in your billing process.
• The Fix: View denials as essential feedback. Create a systematic process to track every denial, analyze the reason code provided by the payer, and take corrective action promptly. This may involve correcting simple errors, submitting additional documentation, or filing formal appeals. Analyzing denial trends can pinpoint areas needing process improvement.

Focus on Your Patients, Let Experts Handle the Billing Complexities

Avoiding these common billing pitfalls requires ongoing diligence, specialized knowledge, and consistent effort – resources that are often stretched thin in a busy practice. Managing the intricate and constantly shifting rules of insurance payers, coding regulations, and compliance requirements can easily consume valuable time and energy.

This is where Legacy Practice Solutions, LLC can be a strategic partner. We specialize in comprehensive medical and dental billing and practice management services. We help practices throughout Connecticut and beyond streamline their revenue cycle, minimize errors, improve cash flow, and maintain compliance, allowing you and your team to dedicate your focus to delivering excellent patient care.

Ready to reduce billing headaches and strengthen your practice's bottom line?

Visit our website at www.legacypsct.com to discover how our tailored solutions can benefit your medical or dental practice. Stop letting preventable errors erode your revenue – let Legacy Practice Solutions help you achieve greater financial efficiency and peace of mind.